Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy

Objective: To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG-PET).Methods: We studied patients with refractory focal epilepsy at high (n = 56) and low...

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Autores principales:	Benjamin P. Whatley, Joel S. Winston, Luke A. Allen, Sjoerd B. Vos, Ashwani Jha, Catherine A. Scott, April-Louise Smith, Fahmida A. Chowdhury, Jamshed B. Bomanji, Samden D. Lhatoo, Ronald M. Harper, Beate Diehl
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	SUDEP positron emission tomography central autonomic regulation cardiorespiratory regulation epilepsy bilateral tonic-clonic seizure Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/b508ff6d66d9490580d8efe2386aad91
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spelling	oai:doaj.org-article:b508ff6d66d9490580d8efe2386aad912021-11-30T15:31:33ZDistinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy1664-229510.3389/fneur.2021.623358https://doaj.org/article/b508ff6d66d9490580d8efe2386aad912021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.623358/fullhttps://doaj.org/toc/1664-2295Objective: To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG-PET).Methods: We studied patients with refractory focal epilepsy at high (n = 56) and low (n = 69) risk of SUDEP who underwent interictal 18FDG-PET as part of their pre-surgical evaluation. Binary SUDEP risk was ascertained by thresholding frequency of focal to bilateral tonic-clonic seizures (FBTCS). A whole brain analysis was employed to explore regional differences in interictal metabolic patterns. We contrasted these findings with regional brain metabolism more directly related to frequency of FBTCS.Results: Regions associated with cardiorespiratory and somatomotor regulation differed in interictal metabolism. In patients at relatively high risk of SUDEP, fluorodeoxyglucose (FDG) uptake was increased in the basal ganglia, ventral diencephalon, midbrain, pons, and deep cerebellar nuclei; uptake was decreased in the left planum temporale. These patterns were distinct from the effect of FBTCS frequency, where increasing frequency was associated with decreased uptake in bilateral medial superior frontal gyri, extending into the left dorsal anterior cingulate cortex.Significance: Regions critical to cardiorespiratory and somatomotor regulation and to recovery from vital challenges show altered interictal metabolic activity in patients with frequent FBTCS considered to be at relatively high-risk of SUDEP, and shed light on the processes that may predispose patients to SUDEP.Benjamin P. WhatleyBenjamin P. WhatleyJoel S. WinstonJoel S. WinstonJoel S. WinstonJoel S. WinstonLuke A. AllenLuke A. AllenLuke A. AllenSjoerd B. VosSjoerd B. VosSjoerd B. VosSjoerd B. VosAshwani JhaCatherine A. ScottCatherine A. ScottApril-Louise SmithFahmida A. ChowdhuryJamshed B. BomanjiSamden D. LhatooSamden D. LhatooSamden D. LhatooRonald M. HarperRonald M. HarperRonald M. HarperBeate DiehlBeate DiehlBeate DiehlFrontiers Media S.A.articleSUDEPpositron emission tomographycentral autonomic regulationcardiorespiratory regulationepilepsybilateral tonic-clonic seizureNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	SUDEP positron emission tomography central autonomic regulation cardiorespiratory regulation epilepsy bilateral tonic-clonic seizure Neurology. Diseases of the nervous system RC346-429
spellingShingle	SUDEP positron emission tomography central autonomic regulation cardiorespiratory regulation epilepsy bilateral tonic-clonic seizure Neurology. Diseases of the nervous system RC346-429 Benjamin P. Whatley Benjamin P. Whatley Joel S. Winston Joel S. Winston Joel S. Winston Joel S. Winston Luke A. Allen Luke A. Allen Luke A. Allen Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Ashwani Jha Catherine A. Scott Catherine A. Scott April-Louise Smith Fahmida A. Chowdhury Jamshed B. Bomanji Samden D. Lhatoo Samden D. Lhatoo Samden D. Lhatoo Ronald M. Harper Ronald M. Harper Ronald M. Harper Beate Diehl Beate Diehl Beate Diehl Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
description	Objective: To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG-PET).Methods: We studied patients with refractory focal epilepsy at high (n = 56) and low (n = 69) risk of SUDEP who underwent interictal 18FDG-PET as part of their pre-surgical evaluation. Binary SUDEP risk was ascertained by thresholding frequency of focal to bilateral tonic-clonic seizures (FBTCS). A whole brain analysis was employed to explore regional differences in interictal metabolic patterns. We contrasted these findings with regional brain metabolism more directly related to frequency of FBTCS.Results: Regions associated with cardiorespiratory and somatomotor regulation differed in interictal metabolism. In patients at relatively high risk of SUDEP, fluorodeoxyglucose (FDG) uptake was increased in the basal ganglia, ventral diencephalon, midbrain, pons, and deep cerebellar nuclei; uptake was decreased in the left planum temporale. These patterns were distinct from the effect of FBTCS frequency, where increasing frequency was associated with decreased uptake in bilateral medial superior frontal gyri, extending into the left dorsal anterior cingulate cortex.Significance: Regions critical to cardiorespiratory and somatomotor regulation and to recovery from vital challenges show altered interictal metabolic activity in patients with frequent FBTCS considered to be at relatively high-risk of SUDEP, and shed light on the processes that may predispose patients to SUDEP.
format	article
author	Benjamin P. Whatley Benjamin P. Whatley Joel S. Winston Joel S. Winston Joel S. Winston Joel S. Winston Luke A. Allen Luke A. Allen Luke A. Allen Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Ashwani Jha Catherine A. Scott Catherine A. Scott April-Louise Smith Fahmida A. Chowdhury Jamshed B. Bomanji Samden D. Lhatoo Samden D. Lhatoo Samden D. Lhatoo Ronald M. Harper Ronald M. Harper Ronald M. Harper Beate Diehl Beate Diehl Beate Diehl
author_facet	Benjamin P. Whatley Benjamin P. Whatley Joel S. Winston Joel S. Winston Joel S. Winston Joel S. Winston Luke A. Allen Luke A. Allen Luke A. Allen Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Sjoerd B. Vos Ashwani Jha Catherine A. Scott Catherine A. Scott April-Louise Smith Fahmida A. Chowdhury Jamshed B. Bomanji Samden D. Lhatoo Samden D. Lhatoo Samden D. Lhatoo Ronald M. Harper Ronald M. Harper Ronald M. Harper Beate Diehl Beate Diehl Beate Diehl
author_sort	Benjamin P. Whatley
title	Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
title_short	Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
title_full	Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
title_fullStr	Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
title_full_unstemmed	Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy
title_sort	distinct patterns of brain metabolism in patients at risk of sudden unexpected death in epilepsy
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/b508ff6d66d9490580d8efe2386aad91
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Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy

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